Viewpoint: All physicians should learn to treat addiction

Medical schools and residency programs need to train future physicians how to treat substance use disorder, according to a June 13 opinion piece written for The Washington Post.

The piece was written by Patrice Harris, MD, a psychiatrist in Atlanta who was president of the American Medical Association from 2019 to 2020; Josiah Rich, MD, a professor of medicine and epidemiology at Providence, R.I.-based Brown University; and Joshua Sharfstein, MD, professor of the practice at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Addiction medicine has been left out of the medical training system due to historical stigma. In the early 20th century, federal authorities arrested thousands of physicians who treated patients with substance use disorders. Since then, many physicians keep their distance from such patients. Now, the stigma is lifting as science recognizes that substance use disorders are tied to chronic illnesses and deserve more care, the authors wrote. 

In 2023, omnibus appropriations legislation was passed that eliminated a law that required physicians to obtain a special waver from the DEA to prescribe buprenorphine. It also added a requirement that physicians receive eight hours of education on substance use disorders before prescribing controlled substances. However, "eight hours is not enough. Physicians need a foundational education on substance use disorders, starting in medical school and continuing through residency," the authors wrote.

Only about half of the nation's medical schools provide sessions during clinical years regarding substance use disorder treatment, and fewer than one-third provide clinical experiences related to addiction, according to a survey by the Liaison Committee on Medical Education. Only about 15 percent of residents and fellows had "experimental training" using medications to treat opioid use disorder, according to a 2021-2022 survey by the Accreditation Council for Graduate Medical Education. 

Yet each year taxpayers provide roughly $15 billion to support residency training through Medicare programs and medical schools receive considerable public funding, the authors wrote, adding: "Amid an ongoing national epidemic of overdose deaths, it is appropriate for Congress to expect schools and training programs to do more to teach doctors to save lives."

Residency training programs are required only to teach residents to "provide instruction and experience in pain management for the specialty, including the recognition of the signs of substance use disorder." But pain management is only a facet of what is needed, the authors wrote.

Fewer than 1 in 6 people receive buprenorphine and methadone, highly effective drugs for opioid use disorder. And the main reason for the failure is physician training, the authors wrote. 

"Opioid use disorder is treatable, and medicines are readily available," they said in the piece. "But doctors cannot learn to help patients by taking a weekend course alone. The training needs to be part of their foundational education. All physicians should emerge from medical school and residency able to give this lifesaving care."

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